Mayo Clinic Health System - Lake City

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

53.7% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — which CMS reads as no different from the national rate. This is CMS’s risk-adjusted rate over 45 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 71.7% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 46 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.16 therapist hours per resident per day in 2026Q1 — more than 14% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 13% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 90 beds and averages 60.4 residents a day — about 67% occupied, or roughly 30 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 4.70 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 1.38 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.52 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 4.30 hrs/resident/day on weekends vs 4.86 on weekdays — 12% thinner on weekends. RN hours go from 1.60 to 0.82 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 44% is about the same as the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

22 citations, most serious first. The 13 most serious are shown; the remaining 9 are one tap away and print in full.

• Immediate jeopardy · J2026-04-20 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review, the facility failed to protect 1 of 1 resident (R1) who had severe cognitive impairment and was unable to give consent for sexual activity from inappropriate sexual touching from R2, who had known history of sexually inappropriate behavior resulting in R2 placing his hand underneath R1's shirt and touching her breast on 4/4/26. This deficient practice resulted in immediate jeopardy (IJ) for R1, as a reasonable person would have experienced severe psychosocial harm, including dehumanization and humiliation as a result of sexual abuse. The Immediate Jeopardy (IJ) began on 4/4/26, when R1's breast was touched by R2 after the facility failed to develop and implement individualized interventions including clearly defined supervision to prevent R2's access to female residents despite a known history of sexually inappropriate behavior. The Administrator and Director of Nursing (DON) were notified of the Immediate Jeopardy (IJ) on 4/16/26 at 1:35 p.m. Immediate…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-04-03 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and document reviews, the facility did not assess or analyze trends in falls to determine causal factors or root causes and implemented individualized interventions aimed at preventing or reducing the risk of falls with major injuries for one of three residents (R1) who experienced falls. This resulted in actual harm when R1 suffered two thoracic spinal fractures and hospitalization after he was left unsupervised on the commode and fell. Findings include: R1's After Visit Summary (AVS) dated 2/1/25 to 2/20/25, identified R1 had a newly diagnosed stroke with left sided hemianopsia (loss of vision in half of visual field) hemiparesis (weakness on one side of body), left sided neglect, and right gaze deviation (condition where the right eye deviates to one side and there's difficulty looking to the opposite side). Further identified R1 had safety considerations due to R1's cognition identified he had poor safety awareness, poor attention/concentration and poor judgement. R1's Fall Risk…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Actual harm · G2024-12-18 · tag F0760 — failed to prevent significant medication errors — isolated
  Ensure that residents are free from significant medication errors.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review, the facility failed to ensure medications were administered to the correct resident for 1 of 3 residents (R1) reviewed for medication errors. This failure resulted in actual harm when R1 became hypotensive that required treatment in the emergency department (ED) and ongoing symptom monitoring and treatment. The facility had implemented appropriate corrective action prior to the onsite investigation so the deficiency is being cited at past non-compliance. Findings include: R1's quarterly Minimum Data Set (MDS) dated [DATE], identified R1's cognition was intact and had diagnoses of chronic kidney disease stage 3b (moderate to severe loss of kidney function) and hyponatremia (low blood sodium). R1's order summary dated 11/18/24, identified R1 was to receive the following oral medications in the morning: acetaminophen (for back pain)1000 milligrams (mg), aspirin (for stroke prophylaxis) 81 mg, citalopram (for depression)10 mg, and multivitamin. R1's medication…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Pharmacy Service Deficiencies · Past Non-Compliance
• Potential for harm · Dcited before2026-04-20 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to report an allegation of resident-to-resident sexual abuse involving 2 of 2 residents (R1) and (R2) to law enforcement, in accordance with established policies and procedures for abuse. Findings include:R1's Face sheet printed 4/16/26, identified R1 had diagnoses of dementia and anxiety disorder.R1's quarterly Minimum Data Set (MDS), dated [DATE], identified that R1 had severe cognitive impairment and used a Wanderguard daily.R1's care plan, revised 8/26/25, identified a focus of risk for vulnerability related to recent placement, impaired cognition, and limited mobility. Interventions, dated 7/30/25, identified that any suspicion of maltreatment was to be reported per facility policy, a safe environment was to be maintained, and suspected incidents of abuse were to be reported to the supervisor.R2's face sheet, printed 4/16/26, identified that R2 had diagnoses of dementia and unspecified mood disorder.R2's quarterly MDS, dated [DATE], identified that…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-04-20 · tag F0610 — failed to investigate and act on abuse reports — isolated
  Respond appropriately to all alleged violations.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure a thorough investigation of an allegation of resident-to-resident sexual abuse for 2 of 2 residents (R1) and (R2), including failure to complete staff and resident interviews and failure to fully assess the circumstances surrounding the incident, reviewed for abuse.Findings include:R1's Face sheet printed 4/16/26, identified R1 had diagnoses of dementia and anxiety disorder.R1's quarterly Minimum Data Set (MDS), dated [DATE], identified that R1 had severe cognitive impairment and used a Wanderguard daily.R1's care plan, revised 8/26/25, identified a focus of risk for vulnerability related to recent placement, impaired cognition, and limited mobility. Interventions, dated 7/30/25, identified that any suspicion of maltreatment was to be reported per facility policy, a safe environment was to be maintained, and suspected incidents of abuse were to be reported to the supervisor.R2's face sheet, printed 4/16/26, identified that R2 had diagnoses of…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-04-20 · tag F0842 — failed to keep accurate, complete medical records — isolated
  Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to maintain a complete and accurate medical record for 1 of 1 resident (R2) when staff did not consistently document episodes of sexually inappropriate comments toward staff, resulting in gaps in behavioral tracking and an inability to accurately evaluate the frequency and severity of R2's behaviors, reviewed for abuse.Findings include:R2's face sheet, printed 4/16/26, identified that R2 had diagnoses of dementia and unspecified mood disorder.R2's quarterly MDS, dated [DATE], identified that R2 had severe cognitive impairment and was independent with wheelchair mobility.R2's behavior care plan focus, revised 4/7/26, identified R2 had behavioral instances of inappropriately sexual touching toward another resident on 9/17/23 and 4/4/26 in the Country View (CV) common area. R2 was identified as being at risk for alteration in behavior due to a diagnosis of dementia and was unable to recall the incidents. The care plan further identified R2 occasionally made…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-12-04 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review the facility failed to comprehensively assess sling/harness sizes according to manufacturer's instructions to ensure safe transfers for 2 of 2 residents (R1 and R3) who utilized mechanical lifts sit to stand lift and full body mechanical lifts for transfers.Findings include:R1's quarterly Minimum Data Set (MDS) dated [DATE], indicated R1's cognition was intact, with diagnoses of generalized anxiety disorder, diabetes, morbid obesity and heart failure. Further indicated an impairment in range of motion (ROM) on both sides of upper and lower extremities and required extensive assist of 2 staff with transfers and used a motorized wheelchair for mobility. R1's Occupational Therapy (OT) treatment encounter note, dated 3/5/24, identified R1 was discharging from OT due to goals met and maximum potential reached. Recommendation for EZ stand use to get to/from chair and toileting (Hoyer (brand of full body lift) as needed). OT note did not identify the size of sling R1…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2025-07-31 · tag F0880 — failed to prevent and control infections — isolated
  Provide and implement an infection prevention and control program.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and document review the facility failed to ensure enhanced barrier precautions (EBP) were implemented with the use of personal protective equipment (PPE) during high-contact resident care activities for 1 of 1 residents (R5) who had a foley catheter, and failed to ensure shared resident equipment was disinfected between uses. Findings include: R5's annual Minimum Data Set (MDS) assessment dated [DATE], identified intact cognition, and substantial/maximal assist was required for bathing and dressing. R5 had an indwelling catheter and diagnoses of severe obesity, heart failure and renal insufficiency. R5's Incontinence/Indwelling Catheter Care Area Assessment (CAA) dated 6/12/25, was triggered due to assistance needed with toileting and an indwelling catheter was required. R5's care plan dated 2/10/25, identified EBP indefinitely due to foley catheter use. Required PPE included gloves and gown prior to the high-contact care activity; Face protection may also be needed if performing…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-06-13 · tag F0582 — isolated
  Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and document review, the facility failed to provide the required written Skilled Nursing Facility Advanced Beneficiary Notice (SNFABN) and Notice of Medicare Non-Coverage (NOMNC) forms to 3 of 3 residents (R2, R162, R258) reviewed whose Medicare A coverage ended and then remained in the facility and/or discharged home. Findings include: R2 R2's Centers for Medicare and Medicaid Services (CMS)-10123 (NOMNC) identified a last covered day (LCD) of 3/13/24. NOMNC indicated community support manager (CSM) called family member (FM)-A, who was also R2's power of attorney (POA), on 3/11/24 to notify that skilled services would be ending on 3/13/24 with financial liability being on 3/14/24. NOMNC lacked signature of FM-A acknowledging notification of services ending. R2's undated Census Records listing identified on 4/14/24, R2's payer source changed from Medicare Part A to Private Pay, and remained in the facility. R2's SNFABN lacked signature acknowledging that FM-A had received and understood the notice. SNFABN indicated beginning on 3/14/24, estimated cost of room and…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-06-13 · tag F0641 — isolated
  Ensure each resident receives an accurate assessment.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to accurately complete the Minimum Data Set (MDS) for 1 of 1 resident's reviewed for wandering. Findings include: R26's admission MDS dated [DATE], indicated severe cognitive impairment, physical and verbal behaviors with rejection of care. Wandering with no significant risk. Wanderguard in place. R26's quarterly MDS dated [DATE] indicated severe cognitive impairment, physical and verbal behaviors directed toward others. No documented wandering. Wanderguard in place. R26's provider orders included mirtazapine (medication for depression and sleep), buspirone (medication for anxiety). R26's diagnoses list included delusional disorders and dementia with anxiety. R26's elopement careplan indicated history of elopement at previous facility in addition to multiple attempts to exit current faciliy with increased wandering during episodes of delusional thoughts. Facility progress notes reviewed from 3/20/24 through 3/27/24 indicated on 3/22/24 R26 attempted to…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-06-13 · tag F0684 — failed to provide proper treatment and quality of care — isolated
  Provide appropriate treatment and care according to orders, resident’s preferences and goals.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and document review, the facility failed to ensure medications were administered per physician's order for 1 of 1 resident (R40) reviewed for assessment prior to medication administration. Findings include: R40's admission Minimum Data Set (MDS) dated [DATE], identified R40 had intact cognition and required assistance with all activities of daily living (ADLs). R40's diagnoses included chronic combined systolic and diastolic heart failure (heart failure that occurs when the heart has trouble relaxing between beats), atrial fibrillation (abnormal electrical impulses suddenly start firing in the atria), heart failure (condition that develops when your heart doesn't pump enough blood for your body's needs), hypertension (pressure in your blood vessels that is too high), obstructive sleep apnea (intermittent airflow blockage during sleep) and chronic obstructive pulmonary disease (lung disease causing restricted airflow and breathing problems). During review of R40's electronic health record…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-06-13 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — isolated
  Provide appropriate pressure ulcer care and prevent new ulcers from developing.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review, the facility failed to provide timely assistance with repositioning to promote healing of pressure ulcer for 1 of 1 resident (R4) in accordance with the individualized care plan. Findings include: R4's annual Minimum Data Set (MDS) dated [DATE], identified R4 had moderately impaired cognition and required assistance with all activities of daily living (ADLs). R4's diagnoses included non-traumatic brain dysfunction (brain damage caused by internal factors), atrial fibrillation (abnormal heart rhythm), heart failure (syndrome cause by an impairment in the heart's ability to fill with and pump blood), renal insufficiency/failure (kidneys are functioning poorly), diabetes mellitus (disease that affect how the body uses blood sugar (glucose)), non-Alzheimer's dementia (loss of memory and other intellectual functions severe enough to cause problems in one's abilities to perform their usual activities), seizure disorder or epilepsy (disorder of the nervous system…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-06-13 · tag F0740 — failed to provide behavioral / mental-health care — isolated
  Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and document review, the facility failed to investigate, review and analyze underlying causes of resident's anxiety and agitation for 1 of 1 resident (R24) who was reviewed for behaviors. Findings include: R24's significant change Minimum Data Set (MDS) dated [DATE], identified R24 had moderate cognitive impairment and diagnoses included dementia, repeated falls, malignant neoplasm of the prostate, weakness, hematuria and recent urinary tract infection. R24 required setup or clean up with personal hygiene and toileting and supervision or touch assist with ambulation. R24 had exhibited behaviors of physical, verbal and other behaviors one to three days during the observation period and wandered daily. R24's behaviors were identified as potentially harmful to himself or others. R24's care plan with review date 6/5/24, identified R24 was at risk for wandering and elopement as he had tried to exit the facility. R24 had impaired cognitive function due to diagnosis of dementia.…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Fines & penalties

$145,117 in federal fines across 2 penalties.

• $112,978 — penalty dated 2026-04-20
• $32,139 — penalty dated 2025-04-03

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Who owns this facility

CMS files one row per role, so the 73 rows in the source record cover these 67 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

2 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

What families pay in MN